Medicare Basics in Ohio: Parts A, B, C, and D Explained

Part A — Hospital insurance

Part A covers inpatient hospital stays, skilled nursing facility care (after a qualifying hospital stay), hospice care, and limited home health services. Roughly 99% of Ohioans on Medicare don't pay a premium for Part A — if you or your spouse worked and paid Medicare payroll taxes for at least 10 years (40 quarters), Part A is "premium-free."

What Part A does cost you when you actually use it in 2026:

Important: Part A uses benefit periods, not calendar years. A benefit period starts the day you're admitted and ends 60 consecutive days after you've been out of inpatient care. If you're readmitted on day 61, that's a new benefit period — and a new $1,736 deductible.

Part B — Medical insurance

Part B covers doctor visits, outpatient services, preventive care, lab tests, durable medical equipment, mental health care, and most outpatient prescription drugs administered in a clinic (chemotherapy, infusions). It's the part you actually use most often.

The 2026 standard Part B premium is $202.90 per month, deducted from your Social Security check if you're receiving one. The annual deductible is $283, after which you pay 20% coinsurance for most services — with no annual cap. That uncapped 20% is the single biggest reason Ohioans buy Medigap or enroll in Medicare Advantage.

If your income is higher

Higher-income beneficiaries pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium. IRMAA in 2026 is based on your 2024 tax return (Social Security uses a two-year lookback):

IRMAA brackets are cliffs, not a smooth phase-in: one dollar of additional income can push you into the next tier and cost you hundreds per year. A one-time event (selling a rental property, a large Roth conversion) can trigger IRMAA two years later. If your income drops afterward because of a "life-changing event" — retirement, divorce, the death of a spouse — you can file Form SSA-44 to ask Social Security to use your current income instead.

Part C — Medicare Advantage

Medicare Advantage (MA) is a private alternative to Original Medicare. When you enroll in an MA plan, you still have Medicare — but instead of the government paying claims directly, you assign your benefits to a private insurer who replaces Parts A and B (and usually Part D) with a single bundled plan.

Most Medicare Advantage plans in Ohio are $0-premium beyond your Part B premium, and many include dental, vision, hearing, fitness (SilverSneakers or Renew Active), over-the-counter drug allowances, and transportation benefits that Original Medicare doesn't cover.

The trade-off: MA plans use networks (HMO or PPO), require prior authorization for many services, and your costs vary based on how often you use care. The 2026 in-network out-of-pocket maximum is $9,250 for in-network services on Medicare Advantage plans — meaning that's the most you'll pay for Part A and B services in a calendar year, no matter how sick you get.

In Ohio, the major Medicare Advantage carriers are Aetna, Anthem Blue Cross Blue Shield, Humana, Medical Mutual of Ohio, UnitedHealthcare, Wellcare, Devoted Health, and CareSource. Network coverage varies wildly — a plan that's strong in Cuyahoga County may have gaps in rural southeast Ohio.

Part D — Prescription drug coverage

Part D is private prescription drug insurance. You can get it either as a standalone PDP (paired with Original Medicare and/or Medigap) or as part of a Medicare Advantage Prescription Drug plan (MAPD).

2026 is the second full year of the Inflation Reduction Act's $2,000 out-of-pocket cap (now indexed up to $2,100). Once your out-of-pocket drug costs reach that cap in a calendar year, you pay $0 for covered drugs for the rest of the year. The maximum deductible any plan can charge in 2026 is $615, and the national base premium is about $38.99/month (though plans range from under $0 to over $100/month).

You can also spread your annual out-of-pocket costs into monthly payments through the Medicare Prescription Payment Plan — a feature added by the IRA. Useful if you have a single expensive drug that would otherwise blow through your deductible in January.

Medigap (Medicare Supplement) — the fifth option

Medigap isn't technically a "part" of Medicare, but it's how most Ohioans who stick with Original Medicare cover the 20% Part B coinsurance and other cost-sharing.

Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N) — meaning a Plan G from Aetna covers exactly the same benefits as a Plan G from Mutual of Omaha. The only differences are price, customer service, and rate-increase history.

The two most popular plans in Ohio are Plan G (covers everything except the small annual Part B deductible) and Plan N (Plan G minus excess charges and with small copays — typically $50–$75/month cheaper). Plan F is still available to anyone who turned 65 before January 1, 2020.

Ohio does not have a "Medigap birthday rule" like California or Oregon — meaning if you want to switch Medigap plans after your initial 6-month open enrollment, you can be medically underwritten and denied based on health. Read more about Medigap in Ohio →

How the parts fit together

For most Ohioans, the practical choice is between two routes:

Route 1: Original Medicare + Medigap + a standalone Part D plan. You pay your Part B premium + a Medigap premium (~$120–$200/mo in Ohio) + a Part D premium (~$0–$80/mo). You can see any provider in the U.S. who accepts Medicare. Costs are highly predictable. Best for snowbirds, frequent travelers, people with serious or chronic conditions, and people who want maximum flexibility.

Route 2: Medicare Advantage (Part C) with built-in drug coverage. You pay your Part B premium and often nothing more in monthly premium. You get extra benefits (dental, vision, fitness, OTC). You're limited to the plan's network. Best for people who stay in Ohio, are reasonably healthy, and want lower up-front costs.

People with retiree coverage from OPERS, STRS, federal service, the VA, or a former employer have a different decision — see our Ohio pensions guide.

2026 Medicare figures at a glance

Sources: CMS 2026 Medicare Parts A & B Premiums and Deductibles (Federal Register); CMS 2026 Part D Final Rule; IRS Rev. Proc. 2025-19.

Common questions